Emend: Nausea and GP

You can have me read this article to you instead of reading it yourself…

Or you can read it the old-fashioned way below…

The symptoms of gastroparesis are incredibly different for each person. As you might imagine, it makes treating gastroparesis not so much of a one-size-fits-all effort by doctors. As much as those of us in the healthcare profession would love to drop each patient into a tidy little box with a set of pre-defined treatments, it just isn’t that easy.

In fact, many people with gastroparesis end up receiving treatments that they don’t need at all, because their symptoms don’t match what their doctor considers “standard”. But I digress. If you’re interested in learning more about that, I discuss it quite a bit in my book. I also discuss it quite a bit in this free chapter from my book about reflux.

Nausea and Vomiting

Today I am going to talk about two major symptoms that people with gastroparesis have to learn to manage on a daily basis: nausea and/or vomiting.

Some people with gastroparesis experience nausea at all times. Others experience it every day, at different times of the day. Yet others only have bouts of nausea periodically. To make things even more confusing, every person who experiences nausea with gastroparesis is not guaranteed to have vomiting to go with it.

To Each His Own

I can give a personal example on this one. I experience what I refer to as a “baseline nausea” at most times of every day. It has changed the way that I operate. Generous people would say that it has made me very graceful. I’d say that really it’s just made me more cautious in my movements – turning more slowly, not bending over unless needed, and then doing so very slowly, etc.

However, I don’t have a lot of vomiting to go with that nausea. If I can keep that baseline nausea under control and keep it from flaring up, then I can get through my day without any real vomiting urges. But that’s not to say that I don’t have the joy of tasting my food more than one time. In fact, I have an unusual symptom of persistent regurgitation. That means that without any vomiting reflex whatsoever, my food comes up anyways.

I like to hypothesize about the fact that this regurgitation might be preventing me from having severe vomiting. But that’s just a hypothesis. The point of this story is to give a personal example of how very different we can all be, even though we might have the same diagnosis of gastroparesis.

How to Treat

And that of course leads us into the issue of treating these symptoms. How can a doctor choose how to treat these symptoms when they are so vastly different between each person?

Great question. I wish I had a great answer.

I have a full chapter in my book about managing nausea. I spend time discussing lifestyle changes, non-medication options, and then, of course, a thorough discussion on medication options.

It becomes clear when reading that chapter that there are quite a few options out there. Unfortunately, many of them don’t work all that well for treating the nausea that comes with gastroparesis. It also becomes clear that certain medications may be better options for certain people and not others.

In that chapter, I discuss over-the-counter drugs like diphenhydramine (Benadryl) and meclizine. I also talk about a slew of prescription drugs, including Compazine, Phenergan, Zofran, Sancuso, Tigan, and Marinol.

But I don’t talk about a newer, relatively popular drug, called…

Emend (Aprepitant)

This drug is in a newer class of medications called neurokinin-1 receptor antagonists. It was originally developed to treat the nausea and vomiting that comes with chemotherapy. And it’s not alone on this. One of the most popular anti-nausea drugs on the market, Zofran (ondansetron), was also originally developed specifically for use with chemotherapy.

Now that we’ve had Emend on the market for a little while, it is being studied for other uses as well. And in the past month, a new, very well done study, evaluated whether or not it works in gastroparesis!

Why Emend?

The main reason that people are interested in using this drug is simply so that we have more options. Even though it seems like there are plenty of options available, many people with gastroparesis are still not able to achieve adequate relief from their nausea and vomiting symptoms.

So more options would be nice.

Another bonus with Emend is that it is only taken once each day. When you have trouble keeping your food down, only having to take something once a day is a nice bonus.

As with any drug, Emend is not without its side effects. But fortunately, they are not all that common with this drug. It can cause some GI upset (constipation and diarrhea, stomach pain, etc) as well as headaches and dizziness, but the occurrence rate is pretty low.

On the other hand, it’s still REALLY expensive. Even though there is a generic option available, it can cost as much as $110/dose. So…that comes out to about $110/DAY. Not cheap.

Does it Work?

The million dollar question!

In this new study that was just published, 72 people with gastroparesis were enrolled to receive either Emend once daily or a placebo for 4 weeks. People receiving the drug experienced some differences compared to those receiving the placebo:

Fewer hours of nausea each day

More days with no nausea

Less severe vomiting episodes (but with no change in the number of episodes)

Less severe bloating

It’s important to note here that people taking Emend did not see their nausea go away completely. In fact, many still experienced nausea on a daily basis. And for people that had vomiting, they did not have fewer vomiting episodes. Instead, they only had less severe vomiting.

So when you ask if Emend works for nausea and vomiting in gastroparesis, the answer is…somewhat. But it’s not a golden ticket. And as far as medication options in gastroparesis go, that isn’t bad.

What Else is There to Know?

Emend is pretty safe, easy to take (once a day), and appears to help some people with gastroparesis to have less nausea than they had when they didn’t take it.

The only part of this that is hard to swallow is the cost, and the fact that insurance might not be willing to pay for you to take one pill each day. However, if you are not able to control your nausea and vomiting with lifestyle changes or the other medication options that are out there, talk to your doctor about a trial on Emend.

Never forget that no medication, no matter the price, is worth it if it is not helping you. The patients that saw an improvement with Emend saw it within the first 2 weeks. If you are not feeling better by then, it is probably best to stop taking it.

Always look out for your own health – you’re the person it matters the most to!

If you’re interested in learning more about treatments for gastroparesis, look here and here. Or you can read more about working with your doctor and treatment team here.

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